the 100% directionless thread

[unleashedfury]

Most legit nosebleed ever. Guy filled an entire emesis bag with blood. 4 neosynephrine packed sponges, ice, and a plug all had zero effect. Hypertension and Coumadin combined to make the poor guy look like a shooing victim.

Also the ambulance has a phantom airhorn (a real one, not the siren). Some awkward moments have ensued as a result.

I remember when I went to EMT school many moons ago and thought oh god blood thinners can't be that bad right?? Until you see them bleed.

Im curious how do they stop it Cauderize?

 

[Aprz]

What you had sounds pretty damn severe. Seen this done once for severe epistaxis in the Emergency Department, and it was successful. The patient also took coumadin (warfarin). I don't know what his INR (international normalized ratio, normal is 1.0, but goal with coumadin is like 2.0-3.0 I think) was. Not sure if this would work on your particular patient, but I'll mention it anyhow.

Items Required
x2 Tongue depressors
x1 Tape

Step 1 Put tongue depressors together.

Step 2 Tape tongue depressors together near one end.

Step 3 Apply tongue depressors to patient's nose.

If I had tongue depressors / popsicle sticks, I'd demonstrate this with pictures. Maybe later?

Edit Found examples online.

http://academiclifeinem.com/trick-of-the-trade-epistaxis-control-with-tongue-blades/

 

[TransportJockey]

Went to my main station in the city and saw our company Xmas tree-man.


Kinda creepy to walk into

 

[Tigger]

What you had sounds pretty damn severe. Seen this done once for severe epistaxis in the Emergency Department, and it was successful. The patient also took coumadin (warfarin). I don't know what his INR (international normalized ratio, normal is 1.0, but goal with coumadin is like 2.0-3.0 I think) was. Not sure if this would work on your particular patient, but I'll mention it anyhow.

Items Required
x2 Tongue depressors
x1 Tape

Step 1 Put tongue depressors together.

Step 2 Tape tongue depressors together near one end.

Step 3 Apply tongue depressors to patient's nose.

If I had tongue depressors / popsicle sticks, I'd demonstrate this with pictures. Maybe later?

Edit Found examples online.

http://academiclifeinem.com/trick-of-the-trade-epistaxis-control-with-tongue-blades/

We actually carry disposable clips, which were to of no effect. Generally I think they cauterize them, although I wonder if some xylocaine with epi could be used to blanch the effected vessel if its visible.

 

[STXmedic]

Those clips are worthless. If pressure doesn't work, we've got oxymetazoline that I've had pretty good success with.

 

[Anjel]

Merry Christmas everyone! Please take care of yourselves! And have a wonderful day! I love you guys!

 

[JPINFV]

What you had sounds pretty damn severe. Seen this done once for severe epistaxis in the Emergency Department, and it was successful. The patient also took coumadin (warfarin). I don't know what his INR (international normalized ratio, normal is 1.0, but goal with coumadin is like 2.0-3.0 I think) was. Not sure if this would work on your particular patient, but I'll mention it anyhow.

Items Required
x2 Tongue depressors
x1 Tape

Step 1 Put tongue depressors together.

Step 2 Tape tongue depressors together near one end.

Step 3 Apply tongue depressors to patient's nose.

If I had tongue depressors / popsicle sticks, I'd demonstrate this with pictures. Maybe later?

Edit Found examples online.

http://academiclifeinem.com/trick-of-the-trade-epistaxis-control-with-tongue-blades/

At my hospital, we have what is essentially a nasal tampon that we can shove into the nasal cavity.

 

[TransportJockey]

I've hard stories of cocaine impregnated gauze being used for that too

 

[STXmedic]

I've hard stories of cocaine impregnated gauze being used for that too

So... Where might one find something like that?... You know, in case someone asks :unsure:

 

[Anjel]

I've hard stories of cocaine impregnated gauze being used for that too

I've seen that used lol

 

[NomadicMedic]

I've always seen the rhino rockets used. I was taught, waaaaaay back when, how to use a foley with the balloon up to tamponade a posterior nosebleed. I've never done it.

I've tried the tongue depressor thing. Eh. Neo-Synephrine spray was in the protocols in WA and worked like a champ.

 

[brian328]

Posting posting posting.. Idk how many more christmas songs i can hear on the radio before my ears start bleeding.

 

[chaz90]

I've tried the tongue depressor thing. Eh. Neo-Synephrine spray was in the protocols in WA and worked like a champ.

I loved using Neo-Synephrine spray for epistaxis. We used to use it for NPA insertion and the rare nasal intubation as well. I can't say I really miss going on nose bleeds though.

 

[NomadicMedic]

I loved using Neo-Synephrine spray for epistaxis. We used to use it for NPA insertion and the rare nasal intubation as well. I can't say I really miss going on nose bleeds though.

I did go on a delta nosebleed. It was ... Prodigious.

... Required extensive decon.

 

[DrankTheKoolaid]

I loved using Neo-Synephrine spray for epistaxis. We used to use it for NPA insertion and the rare nasal intubation as well. I can't say I really miss going on nose bleeds though.

So this got me thinking. While Neo will shrink the blood vessels down don't you also get transient hypertension which could cause any formed clots to break away and risk a continued epistaxis?

 

[chaz90]

Just found out my close friend's puppy was hit and killed by a taxi today. To make it worse, she's living alone in a new city where she's going to school and lost her phone a couple days ago so can't even talk to anyone about it. Talk about a rough Christmas :sad:

 

[exodus]

The switch panel is just oh so festive!

I love those radios, so much better than ours. It actually lets you know when to start talking and whether or not you're connected to the frequency you're broadcasting.

Though I did hate this...

*clicks* booooooooooooooooooooooooooooop
*clicks* boooooooooooooooooooooooooooooop
*clicks* boooooooooooooooooooooooooooop
*clicks* chirp
*clicks* boooooooooooooooooooooooooop

 

[Tigger]

I loved using Neo-Synephrine spray for epistaxis. We used to use it for NPA insertion and the rare nasal intubation as well. I can't say I really miss going on nose bleeds though.

We have neosynephrine, did nothing for this poor patient. This was a delta call and worthy of it. And when he coughed....well I don't think we'll ever be able to find all the blood spatter.

 

[FLdoc2011]

Yea you won't forget a BAD nose bleed. I've had a couple in the hospital that I've had to intubate for airway protection just because they were a severe posterior epistaxis and the person was crapping out.

If it's pretty severe we give them a couple sprays of neo nasal spray and them pack them with a rhino rocket or another similar device made for that. There's several different ones. Some are later or have multiple balloons meant for more posterior bleeds.

Ultimately if it can't be controlled then may need ENT to go look in there and cauterize something or maybe even an interventional radiologist to shoot an angio and find the artery.

 

[Household6]

I've always seen the rhino rockets used. I was taught, waaaaaay back when, how to use a foley with the balloon up to tamponade a posterior nosebleed. I've never done it.

I've tried the tongue depressor thing. Eh. Neo-Synephrine spray was in the protocols in WA and worked like a champ.

Rhino-Rockets and Afrin!!!

We use special Celox nose tampons.. Ancient Indian trick is to roll a 4x4 and stick it behind the upper lip, supposedly there's some pressure points between the lip and gum.